Eyelid Procedure

Blepharoplasty, also known as upper or lower eyelid surgery, helps patients who have puffy, droopy eyelids or deep, bulging bags under the eyes by removing the excess fat, skin, and tissue. Eyelid surgery can help patients who appear tired from sagging eyelids or sad from under eye bags, a common problem in adults over 35 years old in America. 

Plastic surgeon Dr. Robert J. Paresi Jr., MD helps patients regain a youthful, alert appearance with eyelid surgery, sometimes called an eyelid tuck. For some patients, having the excess skin from the upper eyelids can help some patients improve their field of vision in addition to their overall refreshed appearance.

Eyelid surgery has evolved over the last ten years to include augmentation techniques to add volume and improve skin texture in the periorbital area. This is often called “augmentation blepharoplasty”. This often involves the use of the patient’s own fat cells to add volume to the areas around the eyes. The fat is usually harvested from the area around the belly button and processed into ‘microfat’ and ‘nanofat’. 

The microfat is harvested using special instrumentation and processing techniques that results in fat particles that are less than 1 mm in size. The fat is then used to add volume to the periorbital area. In the upper eyelids, it is often the brow area that has lost volume through the aging process. This results in skeletonized, hollow upper eyelids that benefit from the additional volume of microfat grafting. This in combination with skin removal from the upper eyelids will result in a more youthful appearance.

Aging of the lower eyelids is a result of a combination of factors. This can result in crepey skin (wrinkles), lower eyelid bags (excess fat pads), or volume loss (dark circles). Treatment of the lower eyelids often involves a combination of techniques that will treat the different causes of the aging. Wrinkling of the lower eyelid skin with excess skin can often be addressed with raising of a skin flap and skin removal. 

The incision used for the removal is placed in the subciliary location (under the lashes) and is well hidden and inconspicuous. Bulging of the lower eyelids is often a result of redundant fat pads in the periorbital area. A transconjunctival approach (incision inside the eyelid) can be used for removal of the excess fat with no external incision. The bulging of the lower eyelids can also be a result of volume loss of the cheek area resulting in more prominent lower eyelids. In these cases, the patient’s own fat (microfat) is used to augment the upper cheeks and lower eyelids to replace the lost volume resulting in less prominent lower eyelid fat pads.

Dark circles of the lower eyelids are often a result of multiple issues including: skin wrinkles at the inner aspect of the of the lower eyelid, skin pigmentation, loss of volume in the inner aspect of the lower eyelid resulting in the ‘tear trough deformity’, bulging fat pads resulting in a shadow below the bulges, and/or loss of volume of the cheeks resulting in a more prominent tear trough area. 

A customized treatment plan which addresses the underlying causes of the dark circles can result in excellent improvements. Nanofat, or homogenized microfat, is often used for injection into the dark circles (tear trough deformity) and results in improvement of skin texture and correction of pigmentation of the area. Nanofat contains growth factors that have been shown in studies to increase skin thickness resulting in less visible tear troughs.